2013 is rife with reports of the terrible human costs of the flu. Emergency rooms nationwide have been overwhelmed. Art Caplan’s great blog post urges doctors to educate patients that the flu vaccine is not just for their benefit. He tells healthcare providers to send a clear message by getting the flu shot themselves. But what should we do when they refuse?
Flu vaccination of healthcare providers has come a long way. Before 2009, rates never broke 49%. Today, almost two-thirds of healthcare providers are vaccinated.
Still, one-third of healthcare providers do not protect themselves, their patients, and the public from influenza. We remain far short of the national Health People 2020 target of 90%. Do these providers have religious beliefs that raise tricky constitutional and statutory questions? Do they assert deeply held philosophical objections? Media accounts suggest so. We hear of the vegan customer service representative who refuses the flu vaccine because it is grown in chicken eggs, and the religious holistic nurse who objects both to vaccination and to wearing a mask.
But the main reason for going unvaccinated, according to the Centers for Disease Control, is that healthcare providers simply did not want to get vaccinated. Other common reasons: they think flu vaccines don’t work, fear experiencing side effects, or don’t think they will need the vaccine. Some reasons do not reflect the evidence. Others suggest, as Art Caplan puts it that healthcare staff need to “stop thinking only about themselves.”Mandates can counteract this resistance. Many hospitals now require vaccinations, and their coverage rate is 83%. 15% of healthcare providers say they only get the vaccine because their employer requires it. Although hospitals have taken the initiative, other healthcare institutions lag behind. Just 54% of healthcare providers at long-term care facilities are immunized so as to protect their fragile patients.
The regulatory response has been slow. Only a few months ago, Rhode Island became the first state to mandate flu vaccines for healthcare workers with direct contact with patients—in all healthcare settings. Workers who cannot be vaccinated for medical reasons or refuse to be vaccinated must wear surgical masks during periods of widespread flu. State regulation has a number of benefits over ad hoc employer mandates. It applies widely. It recognizes that healthcare workers, whether in the home, hospital, or office, risk spreading illness to vulnerable patients. Regulation ensures patients need not rely on the goodwill of particular institutions or providers. It also avoids the model of employer coercion of employees, and establishes vaccination as a professional obligation. More states should follow Rhode Island’s lead.